The Observatoire en Ville des Plaies ExSudatives (VIPES) study: insight into the patient characteristics, epidemiology, previous management, and features of wounds treated in the French community setting.

BACKGROUND: Wounds that become complex and hard-to-heal are a challenge for all health care systems. Identifying and understanding the nature of these wounds is necessary to allow appropriate intervention. OBJECTIVE: To present the epidemiological outcomes of the VIPES study. MATERIALS AND METHODS: The prospective, observational VIPES study aimed to describe the use and investigate the performance of 2 wound dressings-a silicone foam and a gelling fiber-in the management of chronic and acute wounds in a community setting in France. RESULTS: Of 407 patients recorded, 285 were included in the analysis. The 184 chronic wounds included ulcers (venous/arterial/mixed, diabetic foot, and pressure) and malignant wounds. The 101 acute wounds included surgical and traumatic wounds. Of all wounds, 98.2% were exuding and 77.9% showed exudate pooling. Unhealthy wound edges and periwound skin were reported in 57.2% and 35.4% of wounds, respectively. Of all wounds, 78.6% were in treatment failure (poor exudate management or stagnant wound). The silicone foam dressing (n = 86) and the gelling fiber (n = 199) were generally used in wounds with low or moderate exudation, or moderate or high exudation, respectively. CONCLUSIONS: The VIPES study highlights that wounds can be complex and that community care practices in France warrant improvement. Practical and up-to-date wound management recommendations are needed.

Metabolic Response in Patients With Post-treatment Lyme Disease Symptoms/Syndrome.

BACKGROUND: Post-treatment Lyme disease symptoms/syndrome (PTLDS) occurs in approximately 10% of patients with Lyme disease following antibiotic treatment. Biomarkers or specific clinical symptoms to identify patients with PTLDS do not currently exist and the PTLDS classification is based on the report of persistent, subjective symptoms for ≥6 months following antibiotic treatment for Lyme disease. METHODS: Untargeted liquid chromatography-mass spectrometry metabolomics was used to determine longitudinal metabolic responses and biosignatures in PTLDS and clinically cured non-PTLDS Lyme patients. Evaluation of biosignatures included (1) defining altered classes of metabolites, (2) elastic net regularization to define metabolites that most strongly defined PTLDS and non-PTLDS patients at different time points, (3) changes in the longitudinal abundance of metabolites, and (4) linear discriminant analysis to evaluate robustness in a second patient cohort. RESULTS: This study determined that observable metabolic differences exist between PTLDS and non-PTLDS patients at multiple time points. The metabolites with differential abundance included those from glycerophospholipid, bile acid, and acylcarnitine metabolism. Distinct longitudinal patterns of metabolite abundance indicated a greater metabolic variability in PTLDS versus non-PTLDS patients. Small numbers of metabolites (6 to 40) could be used to define PTLDS versus non-PTLDS patients at defined time points, and the findings were validated in a second cohort of PTLDS and non-PTLDS patients. CONCLUSIONS: These data provide evidence that an objective metabolite-based measurement can distinguish patients with PTLDS and help understand the underlying biochemistry of PTLDS.

Identification of Urine Metabolites as Biomarkers of Early Lyme Disease.

Metabolites detectible in human biofluids are attractive biomarkers for the diagnosis of early Lyme disease (ELD), a vector-borne infectious disease. Urine represents an easily obtained clinical sample that can be applied for diagnostic purposes. However, few studies have explored urine for biomarkers of ELD. In this study, metabolomics approaches were applied to evaluate small molecule metabolites in urine from patients with ELD (n = 14), infectious mononucleosis (n = 14) and healthy controls (n = 14). Metabolic biosignatures for ELD versus healthy controls and ELD versus infectious mononucleosis were generated using untargeted metabolomics. Pathway analyses and metabolite identification revealed the dysregulation of several metabolic processes in ELD as compared to healthy controls or mononucleosis, including metabolism of tryptophan. Linear discriminant analyses demonstrated that individual metabolic biosignatures can correctly discriminate ELD from the other patient groups with accuracies of 71 to 100%. These data provide proof-of-concept for use of urine metabolites as biomarkers for diagnostic classification of ELD.

Evaluation of Modified Two-Tiered Testing Algorithms for Lyme Disease Laboratory Diagnosis Using Well-Characterized Serum Samples.

Standard two-tiered testing (STTT) is the recommended algorithm for laboratory diagnosis of Lyme disease (LD). Several limitations are associated with STTT that include low sensitivity in the early stages of disease, as well as technical complexity and subjectivity associated with second-tier immunoblotting; therefore, modified two-tiered testing (MTTT) algorithms that utilize two sequential first-tier tests and eliminate immunoblotting have been evaluated. Recently, a novel MTTT that uses a VlsE chemiluminescence immunoassay followed by a C6 enzyme immunoassay has been proposed. The purpose of this study was to evaluate the performance of the VlsE/C6 MTTT using well-characterized serum samples. Serum samples from the CDC Lyme Serum Repository were tested using three MTTTs, VlsE/C6, whole-cell sonicate (WCS)/C6, and WCS/VlsE, and three STTTs (immunoblotting preceded by three different first-tier assays: VlsE, C6, and WCS). Significant differences were not observed between the results of the MTTTs assessed; however, the VlsE/C6 MTTT resulted in the highest specificity (100%) when other diseases were tested and the lowest sensitivity (75%) for LD samples. Significant differences were present between the results for various MTTTs and STTTs evaluated. Specifically, all MTTTs resulted in higher sensitivities than the STTTs for all LD groups combined and were significantly more accurate (i.e., higher proportion of correct classifications) for this group, with the exception of the WCS/ViraStripe STTT. Additionally, when other diseases were tested, only the results of the VlsE/C6 MTTT differed significantly from those of the WCS/ViraStripe STTT, with the VlsE/C6 MTTT resulting in a 6.2% higher accuracy. Overall, the VlsE/C6 MTTT offers an additional laboratory testing algorithm for LD with equivalent or enhanced performance compared to that of the other MTTTs and STTTs evaluated in this study.

Metabolic differentiation of early Lyme disease from southern tick-associated rash illness (STARI).

Lyme disease, the most commonly reported vector-borne disease in the United States, results from infection with Borrelia burgdorferi. Early clinical diagnosis of this disease is largely based on the presence of an erythematous skin lesion for individuals in high-risk regions. This, however, can be confused with other illnesses including southern tick-associated rash illness (STARI), an illness that lacks a defined etiological agent or laboratory diagnostic test, and is coprevalent with Lyme disease in portions of the eastern United States. By applying an unbiased metabolomics approach with sera retrospectively obtained from well-characterized patients, we defined biochemical and diagnostic differences between early Lyme disease and STARI. Specifically, a metabolic biosignature consisting of 261 molecular features (MFs) revealed that altered N-acyl ethanolamine and primary fatty acid amide metabolism discriminated early Lyme disease from STARI. Development of classification models with the 261-MF biosignature and testing against validation samples differentiated early Lyme disease from STARI with an accuracy of 85 to 98%. These findings revealed metabolic dissimilarity between early Lyme disease and STARI, and provide a powerful and new approach to inform patient management by objectively distinguishing early Lyme disease from an illness with nearly identical symptoms.

Plasma-modified nitric oxide-releasing polymer films exhibit time-delayed 8-log reduction in growth of bacteria.

Tygon(®) and other poly(vinyl chloride)-derived polymers are frequently used for tubing in blood transfusions, hemodialysis, and other extracorporeal circuit applications. These materials, however, tend to promote bacterial proliferation which contributes to the high risk of infection associated with device use. Antibacterial agents, such as nitric oxide donors, can be incorporated into these materials to eliminate bacteria before they can proliferate. The release of the antimicrobial agent from the device, however, is challenging to control and sustain on timescales relevant to blood transport procedures. Surface modification techniques can be employed to address challenges with controlled drug release. Here, surface modification using H2O (v) plasma is explored as a potential method to improve the biocompatibility of biomedical polymers, namely, to tune the nitric oxide-releasing capabilities from Tygon films. Film properties are evaluated pre- and post-treatment by contact angle goniometry, x-ray photoelectron spectroscopy, and optical profilometry. H2O (v) plasma treatment significantly enhances the wettability of the nitric-oxide releasing films, doubles film oxygen content, and maintains surface roughness. Using the kill rate method, the authors determine both treated and untreated films cause an 8 log reduction in the population of both Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus. Notably, however, H2O (v) plasma treatment delays the kill rate of treated films by 24 h, yet antibacterial efficacy is not diminished. Results of nitric oxide release, measured via chemiluminescent detection, are also reported and correlated to the observed kill rate behavior. Overall, the observed delay in biocidal agent release caused by our treatment indicates that plasma surface modification is an important route toward achieving controlled drug release from polymeric biomedical devices.

Reprint of: Nitric oxide-releasing polysaccharide derivative exhibits 8-log reduction against Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus.

Health-care associated infections (HAIs) and the increasing number of antibiotic-resistant bacteria strains remain significant public health threats worldwide. Although the number of HAIs has decreased by using improved sterilization protocols, the cost related to HAIs is still quantified in billions of dollars. Furthermore, the development of multi-drug resistant strains is increasing exponentially, demonstrating that current treatments are inefficient. Thus, the quest for new methods to eradicate bacterial infection is increasingly important in antimicrobial, drug delivery and biomaterials research. Herein, the bactericidal activity of a water-soluble NO-releasing polysaccharide derivative was evaluated in nutrient broth media against three bacteria strains that are commonly responsible for HAIs. Data confirmed that this NO-releasing polysaccharide derivative induced an 8-log reduction in bacterial growth after 24h for Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus. Additionally, the absence of bacteria after 72 h of exposure to NO illustrates the inability of the bacteria to recover and the prevention of biofilm formation. The presented 8-log reduction in bacterial survival after 24h is among the highest reduction reported for NO delivery systems to date, and reaches the desired standard for industrially-relevant reduction. More specifically, this system represents the only water-soluble antimicrobial to reach such a significant bacterial reduction in nutrient rich media, wherein experimental conditions more closely mimic the in vivo environment than those in previous reports. Furthermore, the absence of bacterial activity after 72 h and the versatility of using a water-soluble compound suggest that this NO-releasing polysaccharide derivative is a promising route for treating HAIs.

Nitric oxide-releasing polysaccharide derivative exhibits 8-log reduction against Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus.

Health-care associated infections (HAIs) and the increasing number of antibiotic-resistant bacteria strains remain significant public health threats worldwide. Although the number of HAIs has decreased by using improved sterilization protocols, the cost related to HAIs is still quantified in billions of dollars. Furthermore, the development of multi-drug resistant strains is increasing exponentially, demonstrating that current treatments are inefficient. Thus, the quest for new methods to eradicate bacterial infection is increasingly important in antimicrobial, drug delivery and biomaterials research. Herein, the bactericidal activity of a water-soluble NO-releasing polysaccharide derivative was evaluated in nutrient broth media against three bacteria strains that are commonly responsible for HAIs. Data confirmed that this NO-releasing polysaccharide derivative induced an 8-log reduction in bacterial growth after 24h for Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus. Additionally, the absence of bacteria after 72h of exposure to NO illustrates the inability of the bacteria to recover and the prevention of biofilm formation. The presented 8-log reduction in bacterial survival after 24h is among the highest reduction reported for NO delivery systems to date, and reaches the desired standard for industrially-relevant reduction. More specifically, this system represents the only water-soluble antimicrobial to reach such a significant bacterial reduction in nutrient rich media, wherein experimental conditions more closely mimic the in vivo environment than those in previous reports. Furthermore, the absence of bacterial activity after 72h and the versatility of using a water-soluble compound suggest that this NO-releasing polysaccharide derivative is a promising route for treating HAIs.

Fabrication of a platform to isolate the influences of surface nanotopography from chemistry on bacterial attachment and growth.

Billions of dollars are spent annually worldwide to combat the adverse effects of bacterial attachment and biofilm formation in industries as varied as maritime, food, and health. While advances in the fabrication of antifouling surfaces have been reported recently, a number of the essential aspects responsible for the formation of biofilms remain unresolved, including the important initial stages of bacterial attachment to a substrate surface. The reduction of bacterial attachment to surfaces is a key concept in the prevention or minimization of biofilm formation. The chemical and physical characteristics of both the substrate and bacteria are important in understanding the attachment process, but substrate modification is likely the most practical route to enable the extent of bacterial attachment taking place to be effectively controlled. The microtopography and chemistry of the surface are known to influence bacterial attachment. The role of surface chemistry versus nanotopography and their interplay, however, remain unclear. Most methods used for imparting nanotopographical patterns onto a surface also induce changes in the surface chemistry and vice versa. In this study, the authors combine colloidal lithography and plasma polymerization to fabricate homogeneous, reproducible, and periodic nanotopographies with a controllable surface chemistry. The attachment of Escherichia coli bacteria onto carboxyl (plasma polymerized acrylic acid, ppAAc) and hydrocarbon (plasma polymerized octadiene, ppOct) rich plasma polymer films on either flat or colloidal array surfaces revealed that the surface chemistry plays a critical role in bacterial attachment, whereas the effect of surface nanotopography on the bacterial attachment appears to be more difficult to define. This platform represents a promising approach to allow a greater understanding of the role that surface chemistry and nanotopography play on bacterial attachment and the subsequent biofouling of the surface.

Conformal encapsulation of three-dimensional, bioresorbable polymeric scaffolds using plasma-enhanced chemical vapor deposition.

Bioresorbable polymers such as poly(ε-caprolactone) (PCL) have a multitude of potential biomaterial applications such as controlled-release drug delivery and regenerative tissue engineering. For such biological applications, the fabrication of porous three-dimensional bioresorbable materials with tunable surface chemistry is critical to maximize their surface-to-volume ratio, mimic the extracellular matrix, and increase drug-loading capacity. Here, two different fluorocarbon (FC) precursors (octofluoropropane (C3F8) and hexafluoropropylene oxide (HFPO)) were used to deposit FC films on PCL scaffolds using plasma-enhanced chemical vapor deposition (PECVD). These two coating systems were chosen with the intent of modifying the scaffold surfaces to be bio-nonreactive while maintaining desirable bulk properties of the scaffold. X-ray photoelectron spectroscopy showed high-CF2 content films were deposited on both the exterior and interior of PCL scaffolds and that deposition behavior is PECVD system specific. Scanning electron microscopy data confirmed that FC film deposition yielded conformal rather than blanket coatings as the porous scaffold structure was maintained after plasma treatment. Treated scaffolds seeded with human dermal fibroblasts (HDF) demonstrate that the cells do not attach after 72 h and that the scaffolds are noncytotoxic to HDF. This work demonstrates conformal FC coatings can be deposited on 3D polymeric scaffolds using PECVD to fabricate 3D bio-nonreactive materials.

Antibacterial activity studies of plasma polymerised cineole films.

Costs associated with bacterial infections in medical devices exceed $US 30 billion each year in the United States alone due to device revisions and patient treatment. Likewise, in 2012-2013, 126 surgical bacterial infections cost a single Australian state over $AUD 5 million. In the search for coatings that can prevent bacterial attachment and reduce medical and human costs, a number of studies have explored the application of antibacterial and anti-fungal essential oils. Traditionally the antibacterial properties of tea tree oils have been linked to their major component terpinen-4-ol, with little focus on the second component, 1,8-cineole. In this study we explore the antibacterial behaviour of solutions of cineole and demonstrate its ability to significantly reduce Escherichia coli viability in solution. However, one of the challenges with essential oils is their limited reactivity and solubility, creating a significant limitation for translating these antibacterial oils into coatings for medical devices. Previous studies have shown that plasma polymerised thin films can be produced from 1,8-cineole (ppCo), though it is unknown if the antibacterial activity can be retained. Herein, we report the behaviour of ppCo films when exposed to different solvents, and the interaction of these films with two bacteria (Escherichia coli and Staphylococcus aureus) commonly related to the failure of medical devices. While a reduction in bacterial attachment was observed onto both the ppCo film and the control hydrophobic surface, only the ppCo coatings resisted biofilm formation after 5 days of incubation with Escherichia coli. Additionally, ppCo films were shown to be non-adherent and non-cytotoxic to mammalian fibroblast. The combination of these two findings suggests that while the ppCo films retained part of the antimicrobial activity of the cineole oil, any leachables that may be released from the coating are also not cytotoxic or cell disruptive to mammalian cells. These coatings present a promising approach toward creating biocompatible antimicrobial coatings from Australian essential oils.

Nitric oxide-releasing S-nitrosated derivatives of chitin and chitosan for biomedical applications.

Nitric oxide (NO)-releasing derivatives of chitin and chitosan were prepared through incorporation of the symmetrical dithiols 1,2-ethanedithiol, 1,3-propanedithiol, and 1,6-hexanedithiol, followed by S-nitrosation with tert-butyl nitrite. The NO loading of the materials and their real-time NO release profiles under physiological conditions (pH 7.4 phosphate buffered saline, 37 °C) were recorded over 24 hours, and in vitro cytotoxicity studies were performed using human dermal fibroblasts (HDF) to assess the suitability of the materials for biomedical applications. Of the six thiolated parent materials, five exhibited cell viability higher than 70% (MTS assay), an outcome that was corroborated by LIVE/DEAD assay. In all cases, HDF morphology was unaffected by the presence of extracts obtained from the thiolated materials.